198020602-2-2-2021-33-CC-NTCG-BXV3HS-20210202171624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020602
Report Date: 02/02/2021
Date Signed: 02/02/2021 05:18:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ATHWAL FAMILY CHILD CARE		FACILITY NUMBER:	198020602
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	02/02/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Sukhjit Athwal - Licensee		TIME COMPLETED:	05:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an announced licensee-initiated case management inspection to evaluate the facility for a capacity increase. Due to COVID-19 and precautionary measures, this inspection was conducted with Licensee Sukhjit Athwal, via a tele-inspection on the FaceTime application at 3:00pm. The purpose of the tele-inspection was due to the licensee's request to increase to a Large Family Child Care Home.

Licensee confirmed that those residing in the home are 1 adult and 1 child. Present during the inspection were 2 adults and 4 children. During the inspection, the licensee’s volunteer assistant was present. Facility hours of operation are Monday to Friday, 8am to 5pm. Licensee cares for children 0-12 years old.

This is a ground level apartment unit with an open floor plan. Areas identified on the facility sketch as accessible to children include: kitchen, activity wall, learning center, living room/bedroom, baby play area, nursery, storage closet, bathroom, and main play area.

Areas off limits based on facility sketch submitted to children and parents include: None.

At 3:02pm, LPA was led on a tour of the home via FaceTime. At the parent’s entry, LPA observed a parent board with all required documents visibly posted. At 3:05, LPA examined the fire extinguisher and observed it to be serviced as of 10/26/2020. There are carbon monoxide detectors and smoke detectors located in the Baby play area and kitchen, respectively. LPA observed the licensee test both and both alarms were found to be heard and operational. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. At 3:15pm, licensee stated there are no pets, poisons, weapons, or firearms on the property.

REPORT CONTINUES PAGE 1 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ATHWAL FAMILY CHILD CARE	FACILITY NUMBER: 198020602
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/09/2021 Section Cited	1 2 3 4 5 6 7	102370(c) Criminal Record Statement (c) All individuals subject to a criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508) under penalty of perjury. This regulation was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation and interview, the licensee did not ensure Staff 01 had completed a LIC508 Criminal Record Statement form as evidenced by its absence from Staff 01's file. This poses a potential risk to the safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ATHWAL FAMILY CHILD CARE	FACILITY NUMBER: 198020602
	VISIT DATE: 02/02/2021

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The tour continued to the outdoor space at 3:15pm. LPA observed the outdoor spaced to be surrounded by a fence with adequate shade and age appropriate play equipment for children in care. At 3:20pm, Licensee assisted LPA in review of 2 children’s files and 1 file for the assistant. At 3:25pm, during review of the staff file for the volunteer, LPA observed that the staff file was missing the LIC508 Criminal Record Statement and Exemption Letter. LPA discussed with the licensee that these are required to be in the files of all adult staff in the facility, per Title 22 regulations. There is a fire clearance on file for the facility that was approved on 10/21/2021.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

The licensee has been approved fire clearance on file by South Pasadena Fire Department, however at this time the licensee is not in compliance with Title 22 of California Code of Regulations as a licensed Small Family Child Care Home. Application is pending review upon receipt of corrections.

The exit interview was conducted with Licensee Sukhjit Athwal at 5:05pm. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt or confirmation of receipt of the email, which will act as the licensee’s signature.

END OF REPORT PAGE 2 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

LIC809 (FAS) - (06/04)

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